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Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. 7 7'4-'17 25- Alterations•:r NORTHAMPTON, MASS. � M 1 (4' 19 7 Z Additions
F APPLICATION FOR PERMIT TO ALTER Repair
Garage
I. Location C(' r (\ t":‘....--T'77 CD Qs, t-c/C Lot No.
2. Owner's name ! c: `A • r___ G /-1— Address rTh„ 0,0 -11 ..
y
3. Builder's name It--)n 19 c t r'?J [ .f , :id?Aka Address I �y 6E/4 j,{ a - 4 �Et�!
! 1 e �f�l
Mass.Construction Supervisor's License No. C.--.. 0 to 6-62 9 Expiration Date IP I'V7
4. Addition
5. Alteration
6. New Porch
7. Is existing building to be demolished?
8. Repair after the fire
9. Garage No.of cars Size
10. Method of heating
11. Distance to lot lines
12. Type of roof fp 13. Siding house � Vf �- -t,,44- ,i _. S-i� i2 t t� C
14. Estimated cost- C- ,,)
The undersigned certifies that the above state is are true to the best of his, her
knowledge ef.
(am"
_,-)A 4
, ,,45,-.7„- _ , j'
, ../ i 6- ,A
Signature of responsible app icant
Remarks
•
#o�KTOy
a� °• C�i oaf nz l ant inn
iit=*°-
• tt �+ et:t SaltssRc11n%ct1II gle
ca-,,.„ "'� DEPARTMENT OP BUILDD'ZG INSPECTIONS t 4 -I`
212 Main Street • Municipal Building
Northampton, Mass. 01060 r
-1ORS{ER'S COMP
,_,
SA'TION INSURANCE A II' )AvTT
1, .C.1)6:1)--,412-k- 1-Th ,t, (1 ifi_t1---er- -(-_)
O ns ,/permi ttec)
with a principal place of business/residen at:
). ),\-121.0_ i �. k � u,cone#) 77 - f -- , -
i _,
- rmiicaty/ :p) Of�".. i
do hereby certify, under the pains and penalties or perjury, thai:
( ) I am an employer providing the following worker's compensation coverage for my
employees wornng on this job:
(Lnsurance Company) (Policy Number) (Expiration Date) w.,
am a sole proprietogeneral contractor or homeowner (circle one) and have hired
contractors ontractors listed below who have the following worker's compensation policies:
(Name of Contractor) cl.n_nuancc Company/Policy Number) (Expiration Date)
(Name of Contractor) lnsuranca Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insuranca Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Dare)
(attach additiocul rood ifncocnr.ry to inc11.16k infocmaaoo patnimng to all coo radon)
am a sole proprietor and have no one woridng for me.
( ) I am a home owner performing all the work myself.
NOTE:please be aware that whilo bomcowncrt wbo employ pazoto to do m.ir,tr r r,construction-or repair work.on a ctwr Ling of
not more than three,units in which the bomoowocr resides or on the goundr appurtenant thereto are not generally oomidcred to be
• employee trader tbo worker's o eticn Act(G L1523s 1(5)),application by a homeowner far a licanse oc permit may evidence the
1cga1 ttatua of an cnployer uodertho Worker's Compamation Act'
•
I understand that a.copy of this carcmazi may be forwarded to the Department of Iod,n tier'Acadmb'Moe of Ism-lc-woe for the
coverage verification sad that failure to secure covcrago under section 25A of MOL 152 can lead to the'imposition of criminal penalties
coatistiag of a•fine of up to S1,300.00 and/or imprisonment of up to one year and civil penalties in the form of a Stop Work Order and a
fine of S 100.00 a day against me. .
Signed this I Lk- day of 1\41.0 , Fordt„oonty
Permit Number
Map# Lot#
Signature of Lice se /Permittee i`
. F
10. Do any signs exist on the property? YES NO
IF YES,describe size, type and location:
Are there any proposed changes to or additions of signs intended for the property?YES NO
IF YES,describe size,type and location:
11 . ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This cols to be filled in
by the Building Department
Required
Existing Proposed By Zoning
Lot size
Frontage
Setbacks - frnnt
- side L: R: L: R:
- rear
Building height
Bldg Square footage
%Open Space: ■
(Lot area minus bldg
&paved parking)
pf -.Parking Spaces
_r-
# of Loading Docks
Fill:
(vol-time--& location)
13 . Certification: I hereby certify that the information contained herein
r- is true and accurate to the best of my know y.
D7�TE: C ►-� i1..''.,� I '`�„ CCj'�f"�'PLICANT's SIGNATURE -,.�� ) �J
NOTE: Issuanme a zoning permit does not relieve ah appljbant's burden to comply with a
zoning requiren n{e and obtain all required permits from the Board of Health, Conservatic
Commission, Department of Publio Works and other applloable permit granting authorities
:`. ,, FILF, /
"° File No.(4."35
t
ZONING PERMIT APPLICATION (§10 . 2
PLEASE TYPE OR PRINT ALL INFORMATION
2
1. Name of Applicant: is > I, - ` ........7-
.)
c j
Address: /9 ( t 6,, � p),/. 9,\L, °/ J� elphon / ? ,j � 't - t �', c�
2. Owner of Property: C ,e 5 a ( <, 4-t ' • ('- �'\-
Of L ,
Address: ��__ �"1�' c)° 1 yf elephone: t- (- - /`'`,, / -1 C1
3. Status of Applicant: Owner X Contract Purchaser Lessee
Other(explain):
4. Street Address: l 1, (j 1
Parcel Id: Zoning Map# 349 L Parcel# #O District(s): (z/2-e----
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property Lit.tAr 9 t-,----}zfk ____ ('`>9)
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
r f
- )<")1.--, 16. K , ( Y,., r
/--e_1(. '? 1 ',. , , ---1, ,,.,, I it -A, ,,,r, A
7. Attached Plans: Sketch Plan Site Plan Engineered/Surveyed Plans
Answers to the following 2 questions may be obtained by checking with the Building Dept or Planning Department Files.
8. Has a Special Permit/Variance/Finding ever been issued for/on the site?
/
NO DON'T KNOW YES IF YES,date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW YES
IF YES: enter Book Page and/or Document#
9. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW YES
IF YES,has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained ,date issued:
(FORM CONTINUES ON OTHER SIDE)
t
a
A 6t) its it \'/ — M �
'1 i �1i t, 1 FILE # l -•
+,, 1
1
°,
L:I MAY 14 1998 ` 3 ,g
APPLICANT/CONTACT PERSON: �j e. `�`Gf/tilek� 6 -639
Di vi i U TRESS�t�t. n''8 : /7O z... .%)/ Ll / t
PROPERTY LOCATION: / ( ( d- ! ' 0 L
MAP , gde' PARCEL: /45- ZONE lz fLe____,
THIS SECTION FOR-OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
7fNTNG FORM FIT J RD OTTT f Fee Paid
Building Permit Filled nut
Fee Paid /Jot ',
New Cnnctrnetinn / -- , •
Remndeling Interior L/..,e,-_-X-e `<21 -L!f'
Addition to FYicting
Arceccnry Structure
re
Building Deane Tnrlurled• (�--v> t `ply
Owner/Occupant Statement nr .hence v"`
I Setc of Planc /Pint Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION:
Approved as presented/based on information presented
Denied as presented:
Special Permit and/or Site Plan Required under: §
PLANNING BOARD ZONING BOARD
Received &Recorded at Registry of Deeds Proof Enclosed
Finding Required under:§ w/ZONING BOARD OF APPEALS
Received&Recorded at Registry of Deeds Proof Enclosed
Variance Required under: § w/ZONING BOARD OF APPEALS
Received&Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW 'Water Availability Sewer Availability
a Z „m a=W" �;.rte ,
Septic t �ier
Well Water Potability-Bd Health
Permit from Conservation/Cotfimission
,„,..-- ,,..-'-:,-,.* - '''Y ,,,,, -5—/d/?g
Signa o t--1,01•!,:,4: ,.-
! o� - Date
NOTE:Issuanoe of a r ning permit does not rayev.ifin applioant's burden to oompiy with ail
_ zoning requirements and obtain ail requmed petWo is from the Board of Health, Conservation
Commission, Department of Publio Worics and other applioable permit granting authorities.
Department: Reference No: BP-1998-0005
Building, Electrical & Mechanical Permits
Fee Type: Receipt No:
Vinyl siding REC-1998-000008
Paid By: Paid in Full On:
Robert Thibodo Tue May 19,1998
Received By: Check No:
Linda Lapointe 6152
DEPARTMENT'S COPY Amount: $20.00
DEPARTMENT FILE COPY 41 CONZ ST
CITY OF NORTHAMPTON
BUILDING PERMIT
Owner's pulling their own permits or dealing with unregistered contractors for applicable work do
not have access to Guaranty Fund(MGL 142A)
Issued: Permit No: i 529 Inspector: Tracking No.: Fee:
18 May, 1998 BP-1998-0005 Stanley Szewczyk 96311 $20.00
GIS #: Map Block: Lot: Address: Zoning: Use Group: Lot Size:
6596 32C 115 001 41 CONZ ST URC 15507.36
Contractor: License Type: Insurance:
Robert Thibodo
Address: License No.: Insurance No.:
P 0 Box 201
City: State: Zip Code: Phone:
NORTHAMPTON MA 01061 (413) 586-0391
Project No: Category of Work: Const. Class: Cost Estimate:
JS-1998-0007 $11,100.00
Description of Work:
install vinyl siding
GeoTMS®1997 Des Lauriers&Associates,Inc. Signature: